Quiz 5

A patient is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which of the following excerpts from the educational brochure warrants correction? A) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start." B) "All things being equal, men have a higher risk of coronary heart disease than perimenopausal women." C) "High blood pressure often accompanies, or even causes, clogging of the arteries." D) "Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease."

A) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start." Cessation of smoking is associated with a decrease in the risk of CHD. Males have an increased risk of atherosclerosis. Atherosclerosis is often associated with hypertension. Lowering cholesterol levels brings a commensurate reduction in risk of CHD.

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? A) "Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." B) "Heart failure will often first show up with persistent coughing and lung crackles." C) "Residents in early heart failure will often be flushed and have warm skin and a fever." D) "Complaints of chest pain are actually more often related to heart failure than to myocardial infarction."

A) "Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." Cognitive changes can often accompany heart failure in the elderly. Pulmonary edema is a later sign, and they are less likely to display coughing, chest pain of flushed skin, and fever.

A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds, A) "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur." B) "Aortic stenosis is commonly seen in elderly patients. Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow." C) "This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends." D) "Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening."

A) "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur." Heart murmur results from turbulent flow through a diseased heart valve that may be too narrow, too stiff, or too floppy. This turbulent flow causes a vibration called a murmur.

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman? A) "Once you have varicose veins, there's little that can be done to reverse them." B) "Your varicose veins are likely a consequence of an existing cardiac problem." C) "If you're able to stay off your feet and wear tight stockings, normal vein tone can be reestablished." D) "The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins."

A) "Once you have varicose veins, there's little that can be done to reverse them." Treatment of varicose veins focuses on prevention and slowing of the progression of the problem; it is not normally possible to reverse existing varicose veins. Staying off one's feet and wearing antiembolic stockings may prevent, but not reverse, the condition. While cardiac problems may coexist with varicose veins, this does not necessarily account for the woman's condition. Blood thinners will not resolve her varicose veins.

As part of presurgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system? A) "The blood pressure varies widely between arteries and veins and between pulmonary and systemic circulation." B) "Only around one quarter of your blood is in your heart at any given time." C) "Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system." D) "Left-sided and right-sided pumping action on each beat of the heart must equal each other to ensure adequate blood distribution."

A) "The blood pressure varies widely between arteries and veins and between pulmonary and systemic circulation." There is a large variation between the higher pressure in the systemic circulatory system and arteries and the lower pressure in the pulmonary system and veins. Approximately 8% of the blood supply is in the heart at any given time. Blood pressure and blood volume are inversely proportionate. The body is able to accommodate short-term differences in left-sided and right-sided output.

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences? A) "You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." B) "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients." C) "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." D) "Fever is a sign of heart failure in children that you are unlikely to see in older adults."

A) "You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." The pulmonary edema that accompanies heart failure is more often interstitial rather than alveolar in children. Jugular venous distention is difficult to gauge in children, and low blood pressure and fever are not noted signs of heart failure in children.

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? A) A 51-year-old male who has been diagnosed with glomerulonephritis B) An African American man who leads a sedentary lifestyle C) A 69-year-old woman with a diagnosis of cardiometabolic syndrome D) A 40-year-old smoker who eats excessive amounts of salt and saturated fats

A) A 51-year-old male who has been diagnosed with glomerulonephritis Damage to the organs that control and mediate the control of blood pressure, most notably the kidneys, is associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.

Which of the following individuals is most likely to be experiencing vasodilation? A) A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system B) A 9-year-old boy who has been given an injection of epinephrine to preclude an anaphylactic reaction to a bee sting C) A 30-year-old woman who takes antihistamines to treat her seasonal allergies D) A 32-year-old man who takes a selective serotonin reuptake inhibitor for the treatment of depression

A) A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system Angiotensin is a potent vasoconstrictor, and medications that block this induce vasodilation. Epinephrine is also a vasoconstrictor. Histamine is a vasodilator, so antihistamine medications are likely to induce vasoconstriction. Serotonin is a vasoconstrictor, so medications that block its reuptake and increase free levels are apt to promote vasoconstriction.

. A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor? A) A 61-year-old man who has a heart valve infection and recurrent fever B) An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness C) A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week D) A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

A) A 61-year-old man who has a heart valve infection and recurrent fever While cardiac complications are common sequelae of hypertension, a heart valve infection would be less likely to be so. Stroke, kidney failure, and angina are all identified as consequences of hypertension.

A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work? A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. B) BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. C) BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. D) BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. BNP is released to compensate for heart failure, and elevated levels help confirm the diagnosis of heart failure as opposed to respiratory etiologies. It does not measure the effectiveness of the RAA system, the risk of cognitive deficits, or the specific severity of pulmonary symptoms of heart failure.

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply. A) Decrease in exercise tolerance B) Exertional dyspnea C) Palpitations D) Syncope E) Heartburn

A) Decrease in exercise tolerance B) Exertional dyspnea D) Syncope Because of the slow onset of aortic valve stenosis, the heart is able to compensate by hypertrophying and may still maintain a normal chamber volume and ejection fraction. As the stenosis progresses, the patient will experience classic symptoms of angina, syncope, heart failure, and decrease in exercise tolerance or exertional dyspnea. Palpitations and heartburn are not usually noted with aortic stenosis.

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply. A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour D) Low pulmonary capillary wedge pressure (PCWP) E) Periods of confusion

A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour E) Periods of confusion Signs and symptoms of cardiogenic shock include indications of hypoperfusion with hypotension (BP 96/60), decrease in mean arterial pressure (MAP) due to poor stroke volume, and a narrow pulse pressure. Urine output decreases because of lower renal perfusion pressures. PCWP is usually elevated due to increased preload. Periods of confusion or altered cognition/consciousness may occur because of low cardiac output.

The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles? A) During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction. B) When the patient starts to snore, his epiglottis is closed over the trachea. C) When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate. D) When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

A) During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction. People with sleep apnea also may experience an increase in BP because of the hypoxemia that occurs during the apneic periods. The specialized chemoreceptors are located in carotid bodies and aortic bodies of the aorta. Retention of fluid is not the cause of increased BP during sleep apnea episodes.

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? A) Echocardiogram, PET scan, ECG B) Ambulatory ECG, cardiac MRI, echocardiogram C) Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy D) Cardiac catheterization, cardiac CT, exercise stress testing

A) Echocardiogram, PET scan, ECG An echocardiogram would provide an image of the client's heart, while a PET scan reveals metabolic activity and an ECG the electrical activity. Answer B would lack data on the client's myocardial metabolism; answer C would lack electrical and physical measurement information; answer D would lack electrical measurement of his heart.

All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? A) Epinephrine (Adrenalin) B) Normal saline infusion C) Dexamethasone (Decadron) D) Diphenhydramine (Benadryl)

A) Epinephrine (Adrenalin) Treatment includes immediate discontinuation of the inciting agent; close monitoring of CV and respiratory function; and maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles.

A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy? A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes. B) Treatment is possible in postpartum women, but antepartum women are dependent on spontaneous resolution of the problem. C) Mortality exceeds 50%, and very few surviving women regain normal heart function. D) Symptomatology mimics that of stable angina and is diagnosed and treated similarly.

A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes. Immune responses, diet, and infections are all potential etiologies of peripartum cardiomyopathy. Treatment is complicated, but not impossible, in antepartum women due to possible teratogenic drug effects. About half of women suffer long-term effects on cardiac function, while signs and symptoms are similar to those of early heart failure.

Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply. A) Large amount of pink, frothy sputum and new onset of murmur B) Tachypnea with respiratory distress C) Frequent ventricular arrhythmia unrelieved with amiodarone drip D) Complaints of facial numbness and tingling E) Enhanced renal perfusion as seen as an increase in urine output

A) Large amount of pink, frothy sputum and new onset of murmur B) Tachypnea with respiratory distress C) Frequent ventricular arrhythmia unrelieved with amiodarone drip D) Complaints of facial numbness and tingling Following MI, many complications can occur: Answer choice A relates to pulmonary edema or papillary muscle rupture; answer choice B refers that acute respiratory distress could result from heart failure; answer choice C relates to life-threatening arrhythmias; answer choice D relates to acute stroke

A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A) Measurement of urine output and mental status assessment B) Pupil response and counting the patient's apical heart rate C) Palpation of pedal (foot) pulses and pain assessment D) Activity tolerance and integumentary inspection

A) Measurement of urine output and mental status assessment Both increased and decreased urine output can be markers of heart failure, as can changes in mental status not attributable to other factors. While heart auscultation, pedal pulses, and activity tolerance are relevant parameters, integumentary inspection, pupil response, and pain assessment are less likely to be relevant assessment components.

Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply. A) Muffled heart tones B) Narrowed pulse pressure C) Low BP—84/60 D) Heart rate 78 E) Bounding femoral pulse

A) Muffled heart tones B) Narrowed pulse pressure C) Low BP—84/60 Cardiac tamponade results in increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and decreased stroke volume and cardiac output. This accumulation of fluid results in tachycardia, elevated CVP, jugular vein distention, fall in systolic BP, narrowed pulse pressure, and signs of shock. Heart sounds may be muffled. A pulse rate of 78 is normal (not tachycardic). With pulsus paradoxus, the arterial pulse as palpated at the carotid or femoral artery becomes weakened (not bulging) or absent with inspiration.

During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found? A) Noted hemorrhages and microaneurysms during evaluation of the internal eye B) Unable to feel vibrations when a tuning fork is placed on the skull C) Inability to locate the kidneys with deep palpation to the abdomen D) Slight increase in the number of varicose veins noted bilaterally

A) Noted hemorrhages and microaneurysms during evaluation of the internal eye Hypertension affects the eye in sometimes devastating ways. If there are acute increases in BP, hemorrhages, microaneurysms, and hard exudates can manifest. Vibrations relate to hearing loss. The kidneys should not be palpable to touch. Varicose veins are not associated with hypertension.

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces C) Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP E) Flushed skin and pounding headache that coincides with each heart beat

A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP ARDS, atelectasis, and acute renal failure are all noted consequences of shock that might be, respectively, treated by dialysis, an ostomy, or platelet transfusion. Plaque formation to heart vessels is not directly related to any of the identified consequences of shock. Pounding headache that coincides with each heart beat may occur with migraine headaches.

A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which of the following phenomena are primarily the contributing factors to hypertension in the elderly population? Select all that apply. A) Stiffening of large arteries like the aorta B) Increased sensitivity of the renin-angiotensin-aldosterone system C) Decreased baroreceptor sensitivity and renal blood flow D) Increased peripheral vascular resistance E) Increase in renal perfusion

A) Stiffening of large arteries like the aorta C) Decreased baroreceptor sensitivity and renal blood flow D) Increased peripheral vascular resistance Increased sensitivity of the renin-angiotensin-aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.

An IV drug abuser walks into the ED telling the nurse that, "he is sick." He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications? A) Systemic emboli, especially to the brain B) Petechial hemorrhages under the skin and nail beds C) GI upset from the massive amount of antibiotics required to kill the bacteria D) Pancreas enlargement due to increased need for insulin secretion

A) Systemic emboli, especially to the brain Systemic emboli develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. Answer choice B refers that petechial hemorrhages are signs and symptoms of IE. GI upset is common following antibiotic therapy but is not usually life threatening. Stress can increase insulin needs but not associated with pancreas enlargement.

A physician is explaining to a group of medical students the concept of Virchow triad as it applies to venous thrombosis. Which of the following clinical observations of a 50-year-old male client is most likely unrelated to a component of Virchow triad? A) The man has decreased cardiac output and an ejection fraction of 30%. B) The man's prothrombin time and international normalized ratio (INR) are both low. C) The man has a previous history of a dissecting aneurysm. D) There is bilateral, brown pigmentation of his lower legs.

A) The man has decreased cardiac output and an ejection fraction of 30%. Cardiac output is not a component of Virchow triad. However, decreased INR and prothrombin time indicate hypercoagulability; a dissecting aneurysm is an example of vessel wall injury; and pigmentation in the lower legs indicates stasis of blood.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place? A) The man's alpa- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. B) Hemolysis and blood pooling are taking place in the man's peripheral circulation. C) Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. D) Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure.

A) The man's alpa- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. alpha- and beta-adrenergic receptor activation is a central response to all types of shock. Hemolysis is not a noted accompaniment to shock. Bronchodilation, not bronchoconstriction, often results from adrenergic stimulation, and sodium-potassium pump failure results in increased extracellular potassium and intracellular sodium.

Which of the following statements most accurately captures a principle of blood flow? A) With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow. B) Blood flow is primarily determined by blood viscosity and temperature. C) Blood flows most quickly in the small diameter peripheral capillaries. D) Smaller cross-sectional vessel area is associated with lower flow velocity.

A) With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow. Doubling the radius of a vessel is associated with a fourth-power increase in flow, provided pressure remains constant. Blood flow is primarily a function of blood pressure, resistance, and viscosity. The small size of capillaries is associated with quite slow velocity, given their large total combined cross-sectional area. Smaller cross-sectional area is associated with greater velocity.

Which of the following medications will likely be prescribed for a patient with elevated LDL and triglyceride levels? A) Zocor (simvastatin), an HMG-CoA reductase inhibitor or "statin" B) Cholestyramine (Questran), a bile acid sequestrant C) Nicotinic acid (Niacin), a B vitamin D) Fenofibrate (Tricor), a fibric acid

A) Zocor (simvastatin), an HMG-CoA reductase inhibitor or "statin" The statins can reduce or block the hepatic synthesis of cholesterol and are the cornerstone of LDL-reducing therapy. Statins also reduce triglyceride levels and increase HDL levels.

A patient arrives at the ED complaining of numbness in the left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses nonpalpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that A) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow. B) submersion in a whirlpool with warm water will improve the venous blood flow and restore pulses. C) the immediate infusion of tissue plasminogen activator (tPA) will not correct the problem and should only be used for CVAs. D) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery to restore perfusion.

A) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow. The presentation of acute arterial embolism is often described as that of the seven "P's": pistol shot, pallor, polar, pulselessness, pain, paresthesia, and paralysis. Treatment is aimed at restoring blood flow. Embolectomy, thrombolytic therapy, and anticoagulant therapy (heparin) are usually given. Application of cold should be avoided.

A 78-year-old male patient has undergone a total knee replacement. He just does not feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and light-headedness. These symptoms are primarily caused by which of the following pathophysiological principles? Select all that apply. The patient('s) A) is experiencing a reduction in plasma volume. B) peripheral vasoconstriction mechanism has failed. C) is so stressed that he is releasing too many endorphins. D) is still bleeding from the surgical procedure. E) has lost all of his muscle tone.

A) is experiencing a reduction in plasma volume. B) peripheral vasoconstriction mechanism has failed. Prolonged bed rest promotes a reduction in plasma volume, a decrease in venous tone, failure of peripheral vasoconstriction, and weakness of the skeletal muscles that support the veins and assist in returning blood to the heart. Endorphins make one feel better in mood. Three days post-op, there should be no further bleeding from the surgical site. If there is, then this is a complication that must be addressed immediately. Loss of vascular and skeletal muscle tone is less predictable but probably becomes maximal after 2 weeks.

When advising a morbidly obese patient about the benefits of weight reduction, which of the following statements would be most accurate to share? A) "All you need to do is stop drinking sodas and sugary drinks." B) "A 10 lb loss of weight can produce a decrease in blood pressure." C) "An increased 'waist-to-hip' ratio can lead to too much pressure on the liver and intestines." D) "If your leptin (hormone) level is too low, you are at increased risk for developing high BP."

B) "A 10 lb loss of weight can produce a decrease in blood pressure." Weight reduction of as little as 4.5 kg (10 lb) can produce a decrease in BP in a large proportion of overweight people with hypertension. There are no data to suggest this patient has a history of high intake of sodas. An increased waist-to-hip ratio is associated with hypertension. Leptin acts on the hypothalamus to increase BP by activating the SNS.

A patient arrived at the emergency department 2 days after the development of "chest pressure" and "tightness" was treated with antacids thinking it was indigestion. His enzymes show a massive myocardial infarction (MI). Following angioplasty, the patient asks why so much muscle was damaged if only one vessel was blocked, the left circumflex. The nurse responds, A) "With any blockage in the heart, muscle damage always occurs." B) "If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow." C) "Since the circumflex artery supplies oxygenated blood flow to the posterior surface of the left ventricle, any amount of blockage will result in vital muscle tissue being lost." D) "When it comes to arteries in the heart, all vessels are equal, and any blockage causes a massive amount of damage that will not be restored."

B) "If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow." Hyperemia cannot occur when the arteries that supply the capillary beds are narrowed. For example, if a major coronary artery becomes occluded, the opening of channels supplied by that vessel cannot restore blood flow.

A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct? A) "I'll inflate the cuff around 30 mm Hg above the point at which I can't palpate the client's pulse." B) "If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low." C) "The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope." D) "With practice, my measurement of clients' blood pressures with this method will be more accurate than with automated machines."

B) "If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low." Undercuffing yields a blood pressure reading that is overestimated. The cuff should indeed be inflated to 30 mm Hg above palpated systolic pressure and is both dependent on clear auscultation of the Korotkoff sounds. The properly performed manual method is more accurate than automated measurement.

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health? A) "People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times." B) "The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel." C) "Infections of any sort are often a signal that plaque disruption is in danger of occurring." D) "The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption."

B) "The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel." Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation. Plaque disruption is noted to correlate with sympathetic events and is not seemingly random; infections and respiratory problems are not noted to be associated with obstruction of blood flow, however.

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client? A) "The normal tissue that makes up the valve between the right sides of your heart has stiffened." B) "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation." C) "Your heart's mitral valve isn't closing properly so blood is flowing backward in your heart and eventually into your lungs." D) "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through."

B) "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation." Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole with left atrial distention and impaired filling of the left ventricle. It does not exist in the right side of the heart, and the problem is associated primarily with improper ventricular filling and with pulmonary backflow only secondarily. Although it is often caused by infection, it is not an infectious process of the valve per se.

In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? A) A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized B) A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation C) A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge D) A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels

B) A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation S3 and S4 irregularities and irregular heart rate are not noted symptoms of pericarditis. Widespread T-wave inversions that later normalize; chest pain radiating to the neck and scapula that is worse on inspiration; and high white cells, erythrocyte sedimentation rate, and C-reactive protein levels are all indicators of pericarditis.

When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate? A) The end result of oxidation is rupture of the plaque resulting in hemorrhage. B) Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. C) Oxidized free radicals produce toxic metabolic waste that can kill liver cells. D) Activated cells roam in the vascular system looking for inflammatory cells to engulf.

B) Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition? A) Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. B) Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. C) Peripheral dilation is associated with decreased stroke volume and ejection fraction. D) Heart valves are not capable of preventing backflow in cases of atrial congestion.

B) Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. Because there are no valves at the entry points to the atria, congestion can result in engorgement of the jugular veins, which are proximal to the heart. Increased cardiac demand is not associated with engorgement of vessels or peripheral dilation.

A 16-year-old adolescent who received a kidney transplant at the age of 10 has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension? A) Furosemide (Lasix) B) Cyclosporine (Sandimmune) C) Isotretinoin (Accutane) D) Hydrochlorothiazide (Hydrodiuril)

B) Cyclosporine (Sandimmune) The nephrotoxicity of the drug cyclosporine, an immunosuppressant used in transplant therapy, may cause hypertension in children after bone marrow, heart, kidney, or liver transplantation.

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? A) Antihypertensive, diuretic, antiplatelet aggregator B) Diuretic, ACE inhibitor, beta-blocker C) Anticoagulant, antihypertensive, calcium supplement D) Beta-blocker, potassium supplement, anticoagulant

B) Diuretic, ACE inhibitor, beta-blocker Diuretics, ACE inhibitors, and beta-blockers are all commonly used in the treatment of heart failure. Antiplatelet aggregators, calcium and potassium supplements, and anticoagulants are less likely to relate directly to a diagnosis of heart failure.

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? A) Chest pain and intermittent ventricular tachycardia B) Dyspnea and crackles in bilateral lung bases C) Petechia and spontaneous bleeding D) Muscle cramping and cyanosis in the feet

B) Dyspnea and crackles in bilateral lung bases Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion.

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? A) CT of the heart, chest x-ray, and ECG B) Echocardiogram, blood cultures, and temperature C) ECG, blood pressure, and stress test D) Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count

B) Echocardiogram, blood cultures, and temperature An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation, and temperature would gauge the presence of infection. A chest x-ray, blood pressure measurement, and cardiac catheterization would be less likely to indicate infective endocarditis.

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient? A) Hyperlipidemia is a consequence of diet and lifestyle rather than genetics. B) HDL cholesterol is often characterized as being beneficial to health. C) Cholesterol is a metabolic waste product that the liver is responsible for clearing. D) The goal of medical treatment is to eliminate cholesterol from the vascular system.

B) HDL cholesterol is often characterized as being beneficial to health. Because it transports cholesterol back to the liver from the periphery, HDL is associated with increased health and lowered risk of atherosclerosis. Genetics play a role in hyperlipidemia, and it is inaccurate to characterize cholesterol as a waste product. Cholesterol is necessary for several physiological processes, and complete elimination is neither realistic nor desirable

A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? A) Increased preload due to vascular resistance B) High afterload because of backpressure against the left ventricle C) Impaired contractility due to aortic resistance D) Systolic impairment because of arterial stenosis

B) High afterload because of backpressure against the left ventricle Increased pressure in the aorta and other arteries constitutes a greater amount of afterload work. This situation is not indicative of increased preload or impaired contractility. Systolic impairment is not a recognized characterization of inadequate cardiac performance.

. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? A) Aneurysms are commonly a result of poorly controlled diabetes mellitus. B) Hypertension is a frequent modifiable contributor to aneurysms. C) Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. D) Aneurysms can normally be resolved with lifestyle and diet modifications.

B) Hypertension is a frequent modifiable contributor to aneurysms. Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.

A patient is admitted to the outpatient diagnostic unit for further testing to identify the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which of the following diagnostic procedures will provide the most definitive diagnosis? A) Routine ultrasound of kidney B) Renal arteriography C) Echocardiography D) Serum creatinine leve

B) Renal arteriography With the dominant role that the kidney assumes in blood pressure regulation, it is not surprising that the largest single cause of secondary hypertension is renal disease. Renal arteriography remains the definitive test for identifying renal artery disease. Ultrasound, CT, and MRA are other tests that can be used to screen for renovascular hypertension.

A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? A) Hypovolemic shock B) Septic shock C) Neurogenic shock D) Obstructive shock

B) Septic shock Low blood pressure accompanied by warm, flushed skin and cognitive changes is indicative of septic shock, as is vessel dilatation and decreased vascular resistance.

Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa? A) The man's blood work indicates polycythemia (elevated red cell levels) and leukocytosis (elevated white cells). B) The man's blood pressure is 178/102, and he has abnormal liver function tests. C) The man is acutely short of breath, and his oxygen saturation is 87%. D) The man's temperature is 101.9°F, and he is diaphoretic (heavily sweating)

B) The man's blood pressure is 178/102, and he has abnormal liver function tests. Polyarteritis nodosa is associated with abnormal liver function and acute hypertension. Anemia, not elevated red cells, is a manifestation, while respiratory symptoms, diaphoresis, and fever are not noted to be accompaniments

Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply. A) Atrial flutter B) Ventricular tachycardia with left bundle branch block pattern C) T-wave inversion in the right precordial leads D) Sinus arrhythmia with a first-degree AV block E) Development of a "U" wave following a normal T wave

B) Ventricular tachycardia with left bundle branch block pattern C) T-wave inversion in the right precordial leads The electrical (ECG) changes associated with ARVC/D include ventricular tachycardia with LBBB, T-wave inversion in the right precordial leads, and epsilon waves. Right ventricular BBB may also be present. Atrial flutter and sinus arrhythmia with a first-degree AV block are not characteristic of this form of cardiomyopathy.

A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could A) decrease renal perfusion and result in the development of ascites. B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C) desensitize the -adrenergic receptors leading to increase in norepinephrine levels. D) prolong the electrical firing from the SA node resulting in the development of a heart block.

B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. An increase in sympathetic activity by stimulation of the -adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and arrhythmias. Acutely, tachycardia significantly increases the workload of the heart, thus increasing myocardial O2 demand and leading to cardiac ischemia, myocyte damage, and decreased contractility. Decreased renal perfusion would activate the RAA system, increasing heart rate and BP further. Ventricular arrhythmias are primarily seen at this stage of HF.

An elderly patient arrives to the health care provider's office complaining of a "sore" that would not heal on his lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is A) hydrotherapy to facilitate improvement in circulation. B) compression therapy to help facilitate blood flow back to the vena cava. C) initiation of Coumadin therapy to maintain an INR of 2 to 3 above norm. D) long-term antibiotic therapy to facilitate healing of the wound.

B) compression therapy to help facilitate blood flow back to the vena cava. Treatment of venous ulcers includes compression therapy with dressings and inelastic or elastic bandages. Medications that help include aspirin and pentoxifylline. Occasionally skin grafting may be required. Hydrotherapy, Coumadin therapy, and long-term antibiotic therapy are usually not required for venous ulcers.

When explaining to a patient why he only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to A) the possibility that the person has elevated INR levels that prevent blood from backlogging in the vessel. B) development of collateral circulation that builds channels between some of the smaller arteries usually when the flow is decreased gradually. C) good genetic makeup that allows occluded arteries to keep vasodilating to meet metabolic needs. D) the release of substances formed by special glands that transport the blood cell-by-cell through smaller spaces.

B) development of collateral circulation that builds channels between some of the smaller arteries usually when the flow is decreased gradually. Collateral circulation is a mechanism for the long-term regulation of local blood flow. Anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When the artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel.

A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. His parents, who believe in "natural remedies," have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for A) myocarditis. B) mitral valve stenosis. C) infective endocarditis. D) vasculitis.

B) mitral valve stenosis. Group A streptococcal infection can be adequately treated with antibiotics, but this infection may have been present long enough to trigger an immune response—rheumatic fever—that will damage his heart valves, ultimately causing mitral valve stenosis. Group A streptococcal infection is not known to predispose to myocarditis, endocarditis, or vasculitis and aneurysm of coronary arteries.

When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have A) no capillary openings since this would lead to extensive hemorrhage. B) small openings that allow large amounts of smaller molecular substances to filter through the glomeruli. C) large pores so that substances can pass easily through the capillary wall. D) endothelial cells that are joined by tight junctions that form a barrier to medication filtration.

B) small openings that allow large amounts of smaller molecular substances to filter through the glomeruli. The glomerular capillaries in the kidneys have small openings called fenestrations that pass directly through the middle of the endothelial cells. These allow large amounts of small molecular and ionic substances to filter through the glomeruli without having to pass through the clefts between the endothelial cells.

During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to hospital. Which of the following statements should the nurse include in response to this? A) "A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy." B) "By avoiding salt, staying active, and minimizing weight gain, you can prevent this during your pregnancy." C) "Essentially, experts don't really know why so many pregnant women develop high blood pressure." D) "I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you."

C) "Essentially, experts don't really know why so many pregnant women develop high blood pressure." The root causes of pregnancy-induced hypertension are not known. It is pathological rather than normal, however, and it cannot necessarily be avoided by lifestyle modifications. It can be pernicious to both the mother and the fetus.

A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis? A) "I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community." B) "With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this." C) "I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." D) "There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible."

C) "I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." Aspirin, exercise, and weight loss are all identified treatments for angina. Angina does not normally necessitate blood work, heparin administration, or avoidance of activity.

On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds, A) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." B) "This could be caused by an infection. Have you been feeling well the past few weeks?" C) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem." D) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed."

C) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem." Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. Blood flow through a normal valve can increase by five to seven times the resting volume. Valvular disease is not caused by stress. The murmur can be caused not only by infection but also by stenosis or regurgitation of a valve leaflet. The valve problem is very severe if it is causing signs of decreased cardiac output.

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function? A) "Efficient heart function requires that the ventricles do not retain any blood at the end of the cardiac cycle." B) "Recall that the heart sounds that we listen to as part of our assessments are the sounds of the myocardium contracting." C) "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." D) "Aortic pressure will exceed ventricular pressure during systole."

C) "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." Diastole is associated with ventricular filling and relaxation. Cardiac output is not 100% or near to it with each cardiac cycle, and heart sounds are associated with valve closing. Ventricular pressure exceeds that of the aorta during systole.

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate? A) "It's important to minimize the amount of potassium and, especially, sodium in your diet." B) "High blood pressure is largely controllable, except for those with a significant family history or African Americans." C) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure." D) "Hypertension puts you at a significant risk of developing type 2 diabetes later in life."

C) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure." Obesity, excess alcohol consumption, and a sedentary lifestyle are all linked with hypertension. Inadequate, rather than excessive, potassium intake is thought to be causative, and while race and family influence an individual's predisposition to hypertension, it does not render the condition untreatable or uncontrollable. Diabetes is thought to be a contributor to hypertension, not vice versa.

Which of the following patients will likely experience difficulty in maintaining lipoprotein synthesis resulting in elevated LDL levels? A) A 55-year-old male admitted for exacerbation of chronic obstructive pulmonary disease (COPD) B) A 44-year-old female admitted for hysterectomy due to cervical cancer with metastasis C) A 35-year-old patient with a history of hepatitis C and B with end-stage liver disease D) A 27-year-old patient with pancreatitis related to alcohol abuse

C) A 35-year-old patient with a history of hepatitis C and B with end-stage liver disease There are two sites of lipoprotein synthesis—the small intestine and the liver. The liver synthesizes and releases VLDL and HDL. IDL are taken to the liver and recycled to form VLDL or converted to LDL in the vascular compartment. Liver disease will result in this mechanism not working as expected. COPD, cervical cancer, and pancreatitis are not involved in elevated LDL levels.

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels? A) A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy B) A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism C) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness D) A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

C) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness Hemorrhagic stroke is not a pathology noted to be associated with secondary hypercholesterolemia. Diabetes, thyroid medications, estrogen therapy, obesity, and beta-blocker medications are all correlated with hypercholesterolemia.

. In which of the following patients is the emergency department staff most likely to suspect an abdominal aortic aneurysm? A) A 60-year-old client with diminished oxygen saturation, low red blood cell levels, and pallor B) A 70-year-old woman with jugular venous distention, shortness of breath, and pulmonary edema C) A 66-year-old client with facial edema, cough, and neck vein distention D) An 81-year-old man with acute cognitive changes as well as difficulty in speaking and swallowing

C) A 66-year-old client with facial edema, cough, and neck vein distention Facial edema, cough, and neck vein distention are associated with abdominal aortic aneurysms. Low red cells, pulmonary edema, and cognitive changes are not associated with abdominal aortic aneurysms.

. In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities? A) A client undergoes a stress test on a treadmill. B) A client does isotonic exercises in a wheelchair. C) A client is helped out of bed and stands up. D) A client reclines from a sitting to supine position.

C) A client is helped out of bed and stands up. During a change in body position, blood is rapidly relocated from the central circulation (when the patient is recumbent) to the lower extremities (when the patient stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction? A) A 33-year-old male whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable. B) A 67-year-old female whose pain started at 2 AM while she was asleep and responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable. C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose. D) A 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened.

C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose. The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other patients have angina of varying severity.

A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable, and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plans listed below? A) Acute arterial occlusion that will be treated with angioplasty B) Raynaud disease that will require antiplatelet medications C) Atherosclerotic occlusive disease necessitating thrombolytic therapy D) Giant cell temporal arteritis that will be treated with corticosteroids

C) Atherosclerotic occlusive disease necessitating thrombolytic therapy The client's symptoms of calf pain with intermittent claudication and diminished pulses are the hallmarks of atherosclerotic occlusive disease. These signs and symptoms are not as closely associated with acute arterial occlusion or giant cell temporal arteritis and are not related to Raynaud disease.

A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider most likelysuspect? A) Pheochromocytoma B) Essential hypertension C) Coarctation of the aorta D) An adrenocortical disorder

C) Coarctation of the aorta The differences in blood pressure between the upper and lower extremities combined with weak femoral pulses and unilateral brachial pulse weakness are associated most strongly with coarctation of the aorta.

While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? A) Decreased vascular perfusion due to parasympathetic stimulation B) Decreased heart rate, contractility, and afterload C) Decreased heart rate as a result of parasympathetic innervation of the heart D) Decreased heart rate as a result of impaired acetylcholine reuptake

C) Decreased heart rate as a result of parasympathetic innervation of the heart Vagal stimulation results in lowered heart rate as a result of parasympathetic stimulation. Vascular perfusion, contractility, and afterload would not be under direct effect. Acetylcholine reuptake would not be influenced.

A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? A) Faster than normal heart rate B) Pain C) Dry and warm skin D) Increased thirst

C) Dry and warm skin In contrast to hypovolemic shock, in which the heart rate is faster than normal and the skin is cold and clammy, a person in neurogenic shock is likely to have a slower than normal heart rate and dry, warm skin. Fainting due to emotional causes is a transient form of neurogenic shock, while increased thirst is an early sign of hypovolemic shock.

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? A) Increased serum creatinine and troponin I as a result of enzyme release from damaged cells B) Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium-potassium pump C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation D) Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response

C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation Myocardial necrosis releases creatine kinase and troponins that normally exist intracellularly. Serum creatinine and potassium are not core markers of heart damage, and myoglobin and creatine kinase levels rise, not fall, with cardiac events.

Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply. A) Increased incidence of mitral stenosis B) Sludge buildup in the kidneys C) Elevated diastolic BP D) Increased vascular stiffness E) Inflammation in the joints due to arthritis

C) Elevated diastolic BP D) Increased vascular stiffness Changes with aging contribute to the development of HF in older adults. First is reduced responsiveness to -adrenergic stimulation. Second is increased vascular stiffness that contributes to ventricular hypertrophy. Third, the heart itself becomes less compliant with age. Fourth relates to altered myocardial metabolism at the level of the mitochondria. Older adults usually develop aortic stenosis and mitral regurgitation. Kidney stones do not contribute to HF. Increase in diastolic pressure compromises LV filling leading to increases in pressures predisposing to HF. Arthritis is not associated with heart failure.

A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output

C) Enlargement of the liver With RV function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion often is one of the first signs on systemic venous congestion in infants and children.

Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)? A) Inadequate ventricular end-diastolic pressure B) Use of calcium channel blocker medications C) Increased aortic pressure D) Ventricular atrophy

C) Increased aortic pressure An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2. Increased, not inadequate, ventricular end-diastolic pressure would cause an increase in MVO2, and medications such as calcium channel blockers would decrease MVO2. Hypertrophy of ventricles would occur in response to prolonged wall stress and consequent oxygen demand.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? A) Resolution of compensatory pulmonary edema and heart arrhythmias B) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility C) Infusion of normal saline or Ringer lactate to maintain the vascular space D) Administration of oxygen and epinephrine to promote perfusion

C) Infusion of normal saline or Ringer lactate to maintain the vascular space Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock and can be achieved in the short term through intravenous administration of saline or Ringer lactate. Resolution of pulmonary edema and heart arrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems? A) Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution. B) Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces. C) Insufficient albumin is causing insufficient absorption of fluid into the capillaries. D) Low albumin contributing to an inability to counter gravitational effects.

C) Insufficient albumin is causing insufficient absorption of fluid into the capillaries. Deficits of plasma proteins like albumin result in insufficient amounts of fluid being absorbed into the capillary circulation by osmotic pressure. It is not a result of hydrostatic pressure, hypertension, or the effects of gravity.

A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which of the following assessments would the nurse be most justified in eliminating during a busy morning on the unit? A) Checking the recent potassium levels of a client receiving an ACE inhibitor B) Measuring the heart rate of a client who takes a alpha-adrenergic blocker C) Measuring the pulse of a client taking an ACE inhibitor D) Noting the sodium and potassium levels of a client who is receiving a diuretic

C) Measuring the pulse of a client taking an ACE inhibitor ACE inhibitors act on the renin-angiotensin-aldosterone system and thus do not significantly influence heart rate. They can, however, induce hyperkalemia, and it would be prudent for the nurse to check potassium levels. -adrenergic blockers affect a client's heart rate, and diuretics can affect electrolyte levels.

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg, and she has proteinuria. What other lab tests should be ordered for her? A) Plasma angiotensin I and II and renin B) Urinary sodium and potassium C) Platelet count, serum creatinine, and liver enzymes D) Urinary catecholamines and metabolites

C) Platelet count, serum creatinine, and liver enzymes This woman shows signs and symptoms of preeclampsia. A low platelet count with elevated serum creatinine and liver enzymes would reinforce this diagnosis. The other tests might indicate kidney problems or the presence of a pheochromocytoma, but her symptoms do not indicate a need for these tests.

The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications? A) Lisinopril, an ACE inhibitor B) Lasix, a diuretic C) Propranolol, a beta-adrenergic blocker D) Lanoxin, an inotropic

C) Propranolol, a beta-adrenergic blocker beta-Adrenergic blockers are generally the initial choice for persons with symptomatic HCM. Calcium channel blockers can also be used. ACE inhibitors, diuretics, or positive inotropics are not the first-line medications.

A 74-year-old man is being assessed by a nurse as part of a weekly, basic health assessment at the long-term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure? A) Blood volume, resistance, and flow B) The cardiac reserve or possible increase in cardiac output over normal resting level C) The amount of blood that his heart ejects from the left ventricle during each beat D) The relationship between total blood volume and resting heart rate

C) The amount of blood that his heart ejects from the left ventricle during each beat Pulse pressure is a reflection of the amount of blood that the heart ejects from the left ventricle during each beat combined with the distensibility of the atrial tree. Other factors such as blood flow characteristics, cardiac reserve, heart rate, and blood volume are less directly associated with pulse pressure.

A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which of the following characteristics of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle? A) The cell samples lack intercalated disks. B) The muscle cells have small and a few mitochondria. C) The cells have a poorly defined sarcoplasmic reticulum. D) The muscles are striated and composed of sarcomeres.

C) The cells have a poorly defined sarcoplasmic reticulum. Cardiac cells have a less clearly defined sarcoplasmic reticulum than do skeletal muscles. They also have intercalated disks and large, numerous mitochondria. Both types of muscles are striated and composed of sarcomeres.

Analysis has shown that a client's right atrial pressure is 30 mm Hg. What is the most likely conclusion that the client's care team will draw from this piece of data? A) The result is likely normal and gravity dependent given the lack of valves in thoracic and central veins. B) The pressure is insufficient to provide adequate stroke volume and cardiac output. C) The pressure is excessive given that the right atrium should be at atmospheric pressure. D) Pressure pulsations are likely to be undetectable given the low atrial pressure.

C) The pressure is excessive given that the right atrium should be at atmospheric pressure. Normal right atrial pressure is around 0 mm Hg, or atmospheric pressure. Right atrial pressure does not have a direct influence on stroke volume or pulse pressure.

During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need? A) Liver and pancreas B) Kidneys C) Veins D) Aorta

C) Veins Compliance refers to the total quantity of blood that can be stored in a given portion of the circulation for each mm Hg rise in pressure. The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure. This allows the veins to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. The liver, pancreas, and kidneys are not vascular components.

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in A) arterial wall weakening resulting in aneurysm formation. B) release of excess fatty plaque causing numerous pulmonary emboli. C) contraction of the underlying smooth muscles within the vessels. D) overproduction of growth factors resulting in new vessel production.

C) contraction of the underlying smooth muscles within the vessels. Endothelial dysfunction describes several types of potentially reversible changes in endothelial function that occur in response to environmental stimuli. Inducers of endothelial dysfunction include cytokines, bacterial, viral, and parasitic products that cause inflammation. They also influence the reactivity of underlying smooth muscle cells through production of both relaxing factors (nitric oxide) and contracting factors (e.g., endothelins).

In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of A) development of hypertension with BP 190/98. B) oxygen deprivation with O2 saturation decreasing to approximately 90%. C) decreasing cardiac output due to less ventricular filling time. D) increasing cardiac index by correlating the volume of blood pumped by the heart with an individual's body surface area.

C) decreasing cardiac output due to less ventricular filling time. One of the dangers of ventricular tachycardia is a reduction in cardiac output because the heart does not have time to fill adequately.

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client A) has a distended bladder, facial edema, and nighttime difficulty breathing. B) complains of dyspnea and has adventitious breath sounds on auscultation (listening). C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. D) has cyanotic lips and extremities, low urine output, and low blood pressure.

C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. Right-sided failure is associated with peripheral edema, fatigue, and, on occasion, upper right quadrant pain. Abdominal distention can occur with right-sided failure when the liver becomes engorge. Facial edema, pulmonary edema, peripheral cyanosis, low urine output, and low blood pressure are less associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs and symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for A) pulmonary hypertension. B) left ventricular hypertrophy. C) organ damage and hypovolemic shock. D) orthostatic hypotension.

C) organ damage and hypovolemic shock. The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. Hospitalization and bed rest predispose to dehydration and low blood volume. Blood pressure normally follows a diurnal pattern in which pressures are highest in the morning. The fact that this client's MAP is falling at a time when it should be at its daily peak is the cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk.

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure? A) "Scarring of the urethra suggestive of recurrent urinary tract infections is evident." B) "Bilateral renal hypertrophy is noted." C) "Vessel wall changes suggestive of venous stasis are evident." D) "Arterial sclerosis of subcortical brain regions is noted."

D) "Arterial sclerosis of subcortical brain regions is noted." Neurological consequences of hypertension include narrowing and sclerosis of subcortical regions. Urethral scarring and impaired venous return would be less likely to derive from hypertension, and while nephrosclerosis and glomerular damage are associated with hypertension, hypertrophy of the kidneys themselves is not noted as an indicator

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught stating, "I've always been healthy, and I can't believe I have a disease now." What would be her physician's most appropriate response? A) "This likely won't have a huge effect on your quality of life, and I'll prescribe anticlotting drugs to prevent attacks." B) "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too." C) "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity." D) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

D) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." Ensuring total body warmth and the use of vasodilators are the normal treatment modalities for Raynaud disease.

A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician? A) "As vessel wall thickness increases, tension decreases." B) "Smaller blood vessels require more pressure to overcome wall tension." C) "The smaller the vessel radius, the greater the pressure needed to keep it open." D) "Tension and vessel thickness increase proportionately."

D) "Tension and vessel thickness increase proportionately." Tension and vessel wall thickness are inversely proportionate, in that thinner blood vessels have greater tension and vice versa. Answer choices A, B, and C all express the correct inverse relationship between tension and wall thickness.

When a 55-year-old patient's routine blood work returns, the nurse notes that his C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds, A) "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels." B) "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein." C) "This means you have high levels of HDL to balance the LDL found in animal proteins." D) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

D) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease." CRP is a serum marker for systemic inflammation. Elevated levels are associated with vascular disease. The normal metabolism of homocysteine requires adequate levels of folate, vitamin B6, vitamin B12, and riboflavin. CRP is not associated with red meat consumption. LDL is an independent risk factor for the development of premature coronary heart disease.

A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? A) "Remember the 'H' in HDL and the 'L' in LDL correspond to high danger and low danger to your health." B) "Having high cholesterol increases your risk of developing diabetes and irregular heart rate." C) "Smoking and being overweight increases your risk of primary hypercholesterolemia." D) "Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk."

D) "Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk." There is a genetic basis to high cholesterol, but lifestyle modification can compensate for many of the increased risks. LDL is more deleterious to health than HDL, and diabetes contributes to high cholesterol but not necessarily vice versa. Hypercholesterolemia resulting from other factors is secondary rather than primary.

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)? A) A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort B) A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin C) A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest STEMI pain is not normally relieved by rest, nor would fever be a common symptom. Shortness of breath, vague chest discomfort, fatigue, GI symptoms, and radiating substernal pain are all associated with STEMI.

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? A) An increase in preload via the Frank-Starling mechanism B) Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine C) Activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) D) AV node pacemaking activity and vagal nerve suppression

D) AV node pacemaking activity and vagal nerve suppression Reassignment of cardiac pacemaking activities and suppression of the vagal nerve are not noted compensatory actions related to heart failure. Increased preload and sympathetic stimulation, increased levels of epinephrine and norepinephrine, and activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) are all noted compensatory mechanisms.

A nurse is providing care for a client who has a history of severe atherosclerosis. Which of the following clinical manifestations of the client's illness should the nurse anticipate and assess in the client? A) Motor deficits in muscles distal to plaque formation B) Peripheral vasodilation to compensate for ischemia C) Cognitive deficits due to ischemia or thrombosis D) Aneurysm formation due to weakening of blood vessel walls E) Necrosis of the vessel wall

D) Aneurysm formation due to weakening of blood vessel walls Aneurysm can be a manifestation of atherosclerosis as a consequence of weakened vessel walls. Motor and cognitive deficits as well as vasodilation are not common manifestations of atherosclerosis. Necrosis of the vessel wall is associated with vasculitis.

A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for? A) Impaired physical restraint of the left ventricle B) Increased friction during the contraction/relaxation cycle C) Reduced protection from infectious organisms D) Impaired regulation of myocardial contraction

D) Impaired regulation of myocardial contraction Regulation of myocardial contraction is not a role of the fibrous covering around the heart. The pericardium does restrain the left ventricle, reduce friction by way of fluid in the pericardial cavity, and provide a physical barrier to infection.

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer thus resulting in decreased vessel lumen radius? A) Nitric oxide B) Adrenal glands C) Fibroblast growth factor D) Norepinephrine

D) Norepinephrine Nerve cells and circulating hormones are responsible for vasoconstriction of the vessel walls. Because they do not enter the tunica media of the blood vessel, the nerves do not synapse directly on the smooth muscle cells. Instead, they release the neurotransmitter, norepinephrine, which diffuses into the media and acts on the nearby smooth muscle cells, resulting in contraction of the entire muscle cell layer and thus reducing the radius of the vessel lumen. This increases the systemic circulation

A nurse is using a stethoscope and blood pressure cuff to manually measure a client's blood pressure. The nurse knows that which of the following facts related to blood flow underlies the ability to hear blood pressure by auscultation (listening)? A) The force of blood with each cardiac contraction produces friction on vessel walls that can be heard and felt. B) The movement of smooth muscle surrounding vessels produces noise that is audible by a stethoscope. C) Turbulent flow of blood during systole produces sound while laminar flow during diastole is silent. D) Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP.

D) Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP. The pressure pulsations that accompany intermittent blood ejection from the ventricles cause sounds that are audible when measuring blood pressure and palpable at pulse sites. Friction, muscle movement, and turbulent blood flow do not account for the pressure pulsations.

Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? A) Pressure in pulmonary circulation and the right side of the infant's heart fall markedly. B) Alveolar oxygen tension increases causing reversal of pulmonary vasoconstriction of the fetal arteries. C) Systemic vascular resistance and left ventricular pressure are both increasing. D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week. One of the hallmarks of the transition from placental circulation is a rapid and then steady decrease in pulmonary vascular resistance. Answers A, B, and C relate normal physiological processes.

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems? A) The patient is male and has a history of hypertension. B) The patient's cardiac ejection fraction was 40% during his last echocardiogram. C) The patient has a history of acute and chronic renal failure. D) The client is 89 years old and takes a diuretic medication for his congestive heart failure.

D) The client is 89 years old and takes a diuretic medication for his congestive heart failure. Old age and diuretic use are strongly associated with orthostatic hypotension, which is normally marked by falls and syncope. Gender, hypertension, stroke volume, and kidney disease are less likely to be causative factors.

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring? A) The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. B) Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. C) Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction. D) The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

D) The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. Angiotensin conversion in the lungs is a component of the renin-angiotensin-aldosterone system that ultimately increases blood pressure and sodium reabsorption. Juxtaglomerular cells release renin, and epinephrine (vasopressin) is responsible for neither initiating the renin-angiotensin-aldosterone system nor directly influencing chemoreceptors and baroreceptors.

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? A) His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. B) His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. C) He is presently volume overloaded following several days of intravenous fluid replacement. D) Ventricular dilation and wall tension are significantly lower than normal.

D) Ventricular dilation and wall tension are significantly lower than normal. Systolic dysfunction is associated with increased ventricular dilation and wall tension. Hypertension, low ejection fraction, high preload, and volume overload are all commonly associated with systolic dysfunction.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to A) have medical supply department bring up suction equipment. B) apply oxygen via nasal cannula at 3 lpm. C) page the respiratory therapist to come give him a breathing treatment. D) call for emergency assistance utilizing hospital protocol.

D) call for emergency assistance utilizing hospital protocol. Mr. V. is experiencing acute pulmonary edema. This is a life-threatening condition. The person is seen sitting and gasping for air. The pulse is rapid, the skin is moist, and the lips/nail beds are cyanotic. Dyspnea and air hunger are accompanied by productive cough with frothy and often blood-tinged sputum (pink). The patient needs the emergency responder team (including ICU nurses, physicians, respiratory therapist, etc.) to intervene. Applying O2 by mask will not increase his oxygen level fast enough, and he is probably mouth breathing (gasping for air). Suction equipment may be needed, but getting a physician to give orders for diuretics and inotropic medications is the priority. Of course respiratory therapist will arrive with the emergency assistance team.